I was recently visited by a woman who had undergone laser removal of her colorful tattoo at a local national-chain studio for 5 years and 29 visits.  Her very recent before-and-after photos from the studio show very little or none improvements.  I suggested her that her provider should use higher laser fluence in order to see improvements.  However, she came back to me that her provider refused to do so.  The only reason I could imagine is that the picosecond laser used by the studio has significant less power than the gold standard Q-switch lasers (the Medlite C6 or the Revlite SI) in the laser tattoo removal industry.  She is now satisfied after two standard Medlite C6 laser treatment visits to us.  The motivation to write this blog is to help people making informative decisions on their unwanted tattoos.

Laser tattoo removal become popular when more and more people have unwanted tattoos.  Although there might be some alternative ways to lighten tattoos, laser tattoo removal is the gold standard treatment to remove tattoos, especially for professional tattoos that are deep and having a lot of inks.  I have seen many people who went for alternatives such as saline injection with tattoo guns complained the ineffectiveness of the alternatives for their professional tattoos. I also have seen unsatisfied people who were treated with low power cheap lasers.  Many people with unwanted tattoos have one common question: what is the best laser tattoo removal in 2021?

For the best laser tattoo removal in 2021, you need to find a good service provider with good lasers and an experienced clinician who is able to provide you the best laser tattoo removal treatment.  Laser tattoo removal relies on old laser technologies that might sound like dinosaurs for millennials.  Physics does not move as fast as computers, smart phones, and self-driving cars.  For people who are interested in the future laser technologies for laser tattoo removal, they could take a look at an US patent issued to me in 2020 (https://patents.google.com/patent/US10806513B2/en?oq=US10806513B2).  For the people who wish to know the best laser tattoo removal in 2021, they should get good information from this blog.

First of all, good lasers are necessary to get the best laser tattoo removal in 2021.  The laser equipment used in laser tattoo removal has recently expanded a little bit.  It now includes not only short pulse lasers such as a good Q-switch laser or a good picosecond laser, but also a fractional CO2 laser that has been proven in clinic for its efficacy in removal tattoo when it is used in combination of short pulse lasers.

There are two types of Q-switch lasers (an active Q-switch laser or a passive Q-switch laser).  The gold standard Q-switch lasers in laser tattoo removal industry are all active Q-switch lasers that have more than 1 J of energy in a single laser pulse, a flat-top beam shape and a less than 5% pulse-to-pulse energy fluctuation.  You could simply google the specification of Medlite-C6 laser and compare it to whatever laser your provider has.  Some provides using active Q-switch lasers that have lower specifications than the gold standard Q-switch lasers would naturally generate unsatisfactory outcome.  The worst laser for laser tattoo removal is a passive Q-switch laser with significant less laser pulse energy, a Gaussian beam shape, and a much higher pulse-to-pulse laser energy fluctuation.  Such worst Q-switch lasers usually have small physical size and none articulated arms for laser delivery.  Comparing to the gold standard Q-switch lasers, the mainstream picosecond lasers are considered equivalent in clinical outcomes by many clinicians in literature.  However, from the woman’s case we mentioned above, we now know it as a fact that the lower pulse energy of the picosecond lasers could make them inferior to good Q-switch lasers in removing ink particles in deep skin tissue.  In summary, a provider need to have both a good short pulse laser and a fractional CO2 laser in order to provide the best laser tattoo removal in 2021.

Second, we can talk about what is the best laser tattoo removal in 2021 now.  Previously, the literature agrees that repetition of laser tattoo removal procedure in a single visit could be the most effective way to improve clinical outcomes.  That procedure is also referred as R20 protocol (repeating with 20 minutes in between) or R0 protocol (repeating with zero minutes in between with the help of gas-bubble removal liquids).  For the R0 protocol, many clinicians have found out that if it is not done correctly for example by using a soaked polymer pads on top of tattooed skin, its clinical outcome is inferior to that of the R20 protocol.  In 2021, more and more experienced clinicians are offering a dual-laser tattoo removal protocol, i.e. using both a good short pulse laser (a gold standard Q-switch laser or a good mainstream picosecond laser) and a fractional CO2 laser for efficiently removing tattoos.  Using dual lasers provide benefits for all kinds of tattoos, especially for colorful tattoos and very professional tattoos that go deep and have a lot of inks.

Why a fractional CO2 laser can help improving outcome of laser tattoo removal?  A fractional CO2 laser is traditionally considered gold standard technology for face rejuvenation for light skin people in removing age spots, reducing wrinkles, and reducing scars.  The fractional CO2 laser prints a matrix of white dots on the skin surface. The white dots are actually white columns in three-dimension because it can extend downward as deep as 1 mm.  When the skin heals from the printed white matrix, the body will push the deeper skin up and replace the white dots or white columns with new skin tissue.  When there are tattoo inks in the deeper skin, some of the tattoo inks are pushed out of the skin surface during wound healing process.  No matter what color the tattoo inks are, they are pushed out without preference.  Even a white tattoo would be pushed out by the fractional CO2 laser. Obviously, it helps the colorful tattoos most especially when there are ink colors that are not responding well to short pulse lasers.

A dual-laser tattoo removal procedure is more efficient in removal tattoos because the fractional CO2 laser provides short cuts for ink particles to be out of the body.  For experienced clinicians, tattoos that are deep in skin are the most difficult tattoos to remove.  The reason is that laser energy reduces exponentially as it goes deep into skin due to the strong scattering of laser light by human skin tissue.  The scattering effects are stronger for visible lasers that are used to treat colorful tattoos.  That is exactly why deep colorful tattoos are the most difficult tattoos to remove.  Fortunately, the “pushing up” of deeper tattoos in skin by a fractional CO2 laser provides a way to efficiently remove tattoos that are the most difficult to remove when a good short pulse laser is used alone.

Let’s examine a before & after figure blow. It is a colorful tattoo that was treated in a single visit with 2 rounds 1064 nm of Medlite-C6 laser with R20 protocol and one round of fractional CO2 laser (Sandstone Matrix LS-40) at our Creve Coeur office.

In the first impression, one might conclude that it just faded a little bit in 4 weeks after 1 visit.  To an experienced clinician, he or she could see more faded black inks if two-rounds of Medlite-C6 laser treatments are done alone without an additional CO2 laser treatment.  Because the “pushing up” action of the CO2 laser treatment brings up more inks from deeper skin, the “pushed-up” inks create a fake impression that only a little bit inks are removed after 1 visit.  From the figure above, we can clearly identify that more red inks particles at deeper depths are pushed up because 1064 nm laser removes very little red inks.  This is my first evidence for the “pushing-up” action of the fractional CO2 laser treatment for the laser tattoo removal.  We started to offer dual-laser tattoo removal service several months ago at TrustedInkAway LLC.  We have seen good clinical outcomes of such a dual-laser treatment procedure in more and more cases in our Creve Coeur office.

In conclusion, the best laser tattoo removal in 2021 is a dual-laser procedure combining multiple rounds of a good short pulse laser (a gold standard Medlite-C6, Revlite-SI, or a mainstream picosecond laser) treatments with one round of a fractional CO2 laser treatment in a single visit.  People who read US10806513B2 would know much more efficient lasers are on the way in the coming years for improving the clinical outcomes of laser tattoo removal.  The significantly improved clinical outcomes will bring down the total cost of removing an unwanted tattoo for consumers.

Leave a comment